The dual impact of antiretroviral therapy and sexual behaviour changes on HIV epidemiologic trends in Uganda: a modelling study
Identifieur interne : 001A09 ( Main/Exploration ); précédent : 001A08; suivant : 001A10The dual impact of antiretroviral therapy and sexual behaviour changes on HIV epidemiologic trends in Uganda: a modelling study
Auteurs : Leigh Anne Shafer [Canada, Ouganda] ; Rebecca N. Nsubuga [Ouganda] ; Ruth Chapman [Royaume-Uni] ; Katie O'Brien [Royaume-Uni] ; Billy N. Mayanja [Ouganda] ; Richard G. White [Royaume-Uni]Source :
- Sexually Transmitted Infections [ 1368-4973 ] ; 2014.
Abstract
Antiretroviral therapy (ART) availability in a population may influence risky sexual behaviour. We examine the potential impact of ART on the HIV epidemic, incorporating evidence for the impact that ART may have on risky sexual behaviour.
A mathematical model, parameterised using site-specific data from Uganda and worldwide literature review, was used to examine the likely impact of ART on HIV epidemiologic trends. We varied assumptions about rates of initiating ART, and changes in sexual partner turnover rates.
Modelling suggests that ART will reduce HIV incidence over 20 years, and increase prevalence. Even in the optimistic scenario of ART enrollment beginning after just five months of infection (in HIV stage 2), prevalence is estimated to rise from a baseline of 10.5% and 8.3% among women and men, respectively, to at least 12.1% and 10.2%, respectively. It will rise further if sexual disinhibition occurs or infectiousness while on ART is slightly higher (2% female to male, rather than 0.5%). The conditions required for ART to reduce prevalence over this period are likely too extreme to be achievable. For example, if ART enrolment begins in HIV stage 1 (within the first 5 months of infection), and if risky sexual behaviour does not increase, then 3 of our 11 top fitting results estimate a potential drop in HIV prevalence by 2025. If sexual risk taking rises, it will have a large additional impact on expected HIV prevalence. Prevalence will rise despite incidence falling, because ART extends life expectancy.
HIV prevalence will rise. Even small increases in partner turnover rates will lead to an additional substantial increase in HIV prevalence. Policy makers are urged to continue HIV prevention activities, including promoting sex education, and to be prepared for a higher than previously suggested number of HIV infected people in need of treatment.
Url:
DOI: 10.1136/sextrans-2013-051219
PubMed: 24567521
PubMed Central: 4112492
Affiliations:
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Nsubuga</name><affiliation wicri:level="1"><nlm:aff id="af2"><institution>Medical Research Council Unit on AIDS/Uganda Virus Research Institute</institution>,<addr-line>Entebbe</addr-line>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Chapman, Ruth" sort="Chapman, Ruth" uniqKey="Chapman R" first="Ruth" last="Chapman">Ruth Chapman</name><affiliation wicri:level="1"><nlm:aff id="af3"><institution>London School of Hygiene and Tropical Medicine</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="O Brien, Katie" sort="O Brien, Katie" uniqKey="O Brien K" first="Katie" last="O'Brien">Katie O'Brien</name><affiliation wicri:level="1"><nlm:aff id="af3"><institution>London School of Hygiene and Tropical Medicine</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Mayanja, Billy N" sort="Mayanja, Billy N" uniqKey="Mayanja B" first="Billy N" last="Mayanja">Billy N. Mayanja</name><affiliation wicri:level="1"><nlm:aff id="af2"><institution>Medical Research Council Unit on AIDS/Uganda Virus Research Institute</institution>,<addr-line>Entebbe</addr-line>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="White, Richard G" sort="White, Richard G" uniqKey="White R" first="Richard G" last="White">Richard G. White</name><affiliation wicri:level="1"><nlm:aff id="af3"><institution>London School of Hygiene and Tropical Medicine</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Sexually Transmitted Infections</title><idno type="ISSN">1368-4973</idno><idno type="eISSN">1472-3263</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objectives</title><p>Antiretroviral therapy (ART) availability in a population may influence risky sexual behaviour. We examine the potential impact of ART on the HIV epidemic, incorporating evidence for the impact that ART may have on risky sexual behaviour.</p></sec><sec><title>Methods</title><p>A mathematical model, parameterised using site-specific data from Uganda and worldwide literature review, was used to examine the likely impact of ART on HIV epidemiologic trends. We varied assumptions about rates of initiating ART, and changes in sexual partner turnover rates.</p></sec><sec><title>Results</title><p>Modelling suggests that ART will reduce HIV incidence over 20 years, and increase prevalence. Even in the optimistic scenario of ART enrollment beginning after just five months of infection (in HIV stage 2), prevalence is estimated to rise from a baseline of 10.5% and 8.3% among women and men, respectively, to at least 12.1% and 10.2%, respectively. It will rise further if sexual disinhibition occurs or infectiousness while on ART is slightly higher (2% female to male, rather than 0.5%). The conditions required for ART to reduce prevalence over this period are likely too extreme to be achievable. For example, if ART enrolment begins in HIV stage 1 (within the first 5 months of infection), and if risky sexual behaviour does not increase, then 3 of our 11 top fitting results estimate a potential drop in HIV prevalence by 2025. If sexual risk taking rises, it will have a large additional impact on expected HIV prevalence. Prevalence will rise despite incidence falling, because ART extends life expectancy.</p></sec><sec><title>Conclusions</title><p>HIV prevalence will rise. Even small increases in partner turnover rates will lead to an additional substantial increase in HIV prevalence. Policy makers are urged to continue HIV prevention activities, including promoting sex education, and to be prepared for a higher than previously suggested number of HIV infected people in need of treatment.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ford, N" uniqKey="Ford N">N Ford</name></author><author><name sortKey="Calmy, A" uniqKey="Calmy A">A Calmy</name></author><author><name sortKey="Mills, Ej" uniqKey="Mills E">EJ Mills</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cohen, Ms" uniqKey="Cohen M">MS Cohen</name></author><author><name sortKey="Chen, Yq" uniqKey="Chen Y">YQ Chen</name></author><author><name sortKey="Mccauley, M" uniqKey="Mccauley M">M McCauley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abbas, Ul" uniqKey="Abbas U">UL Abbas</name></author><author><name sortKey="Mellors, Jw" uniqKey="Mellors J">JW 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Keeling</name></author><author><name sortKey="Rohani, P" uniqKey="Rohani P">P Rohani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Powers, K" uniqKey="Powers K">K Powers</name></author><author><name sortKey="Poole, C" uniqKey="Poole C">C Poole</name></author><author><name sortKey="Pettifor, A" uniqKey="Pettifor A">A Pettifor</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Powers, Ka" uniqKey="Powers K">KA Powers</name></author><author><name sortKey="Ghani, Ac" uniqKey="Ghani A">AC Ghani</name></author><author><name sortKey="Miller, Wc" uniqKey="Miller W">WC Miller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Xiridou, M" uniqKey="Xiridou M">M Xiridou</name></author><author><name sortKey="Geskus, R" uniqKey="Geskus R">R Geskus</name></author><author><name sortKey="De Wit, J" uniqKey="De Wit J">J de Wit</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Canada</li><li>Ouganda</li><li>Royaume-Uni</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Shafer, Leigh Anne" sort="Shafer, Leigh Anne" uniqKey="Shafer L" first="Leigh Anne" last="Shafer">Leigh Anne Shafer</name></noRegion></country><country name="Ouganda"><noRegion><name sortKey="Shafer, Leigh Anne" sort="Shafer, Leigh Anne" uniqKey="Shafer L" first="Leigh Anne" last="Shafer">Leigh Anne Shafer</name></noRegion><name sortKey="Mayanja, Billy N" sort="Mayanja, Billy N" uniqKey="Mayanja B" first="Billy N" last="Mayanja">Billy N. Mayanja</name><name sortKey="Nsubuga, Rebecca N" sort="Nsubuga, Rebecca N" uniqKey="Nsubuga R" first="Rebecca N" last="Nsubuga">Rebecca N. Nsubuga</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Chapman, Ruth" sort="Chapman, Ruth" uniqKey="Chapman R" first="Ruth" last="Chapman">Ruth Chapman</name></noRegion><name sortKey="O Brien, Katie" sort="O Brien, Katie" uniqKey="O Brien K" first="Katie" last="O'Brien">Katie O'Brien</name><name sortKey="White, Richard G" sort="White, Richard G" uniqKey="White R" first="Richard G" last="White">Richard G. White</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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